Nutrition

Nutrition is key to children’s survival and development. Well-nourished children are healthier and cleverer than their undernourished peers, they grow and develop to their full potential, and they perform better in school and as adults. In South Asia, an estimated 38 percent of children under the age of five are stunted due to chronic nutrition deprivation.45 Research shows that there is a critical 1,000-day window of opportunity – from conception to the age of two – to prevent child stunting and break the intergenerational cycle of under nutrition: once this window closes, for most children it closes for life.

In South Asia, stunting in children under the age of five is declining, but the estimated prevalence – 38 percent – is still too high, and comparable to that in sub-Saharan Africa.46 Under nutrition in children can be seen in stunted growth – a stunted child is significantly less tall than would be expected for his or her age.47 We use data on the prevalence of child stunting, between approximately 1990 and 2010, to assess progress and document trends in reducing child under nutrition in South Asia.

Recent global data indicate that 26 percent of children under five years of age (about 165 million) have stunted growth. The same sources indicate that stunting leads to about one million child deaths every year. For the children who survive, stunting in early childhood causes lasting damage, including poor performance at school, reduced lean body mass, short adult stature, lower productivity, reduced earnings and – when accompanied by excessive weight gain later in childhood – a higher risk of chronic diseases.

There is clear evidence that all children have similar growth and development potential in the first years of life. Global evidence also shows that a set of proven interventions from conception to the age of two – the 1,000-day window of opportunity mentioned above – can offer children the best start in life. Policies, programs, research and advocacy therefore need to ensure that:• Children are breastfed within the first hour of life and are fed only breast milk in the first six months of life to grow healthy and strong. • Children are fed the right food – in quantity and quality – and mother’s milk after six months of age with safe and hygienic feeding practices to ensure optimal growth and development.• Children are given essential vitamins and micronutrients, and full immunization, to strengthen their immune systems and protect them from nutritional deficiencies and disease.• Children are given nutritious, life-protecting foods and care when they are sick or severely undernourished to ensure their survival and lasting recovery.• Women benefit from good foods and care, including during adolescence, pregnancy and lactation, to secure their nutrition today and the nutrition of their children tomorrow.

The good news is that we know what works and, increasingly, we know how to make it work. Yet an estimated 38 percent of South Asia’s underfives are stunted. This high prevalence of stunting, combined with the region’s large child population, explains why South Asia bears about 40 percent of the global burden of child stunting. Therefore, accelerating the reduction of stunting in South Asia is key to achieve the global target of reducing the number of stunted underfives by 40 percent by 2025.

The prevalence of stunting among underfives in South Asia has declined from about 61 percent in 1990 to about 38 percent in 2012, which represents a 38 percent decline over the last two decades. Every country has seen a reduction in the prevalence of stunting over the past twenty years. In Bangladesh, Bhutan, the Maldives, Nepal and Sri Lanka the prevalence of stunting declined by more than one third. The average annual rate of reduction in the prevalence of child stunting was 1.7 percent, ranging from about 1.1 percent in Pakistan to about three percent in the Maldives.

However, regional and national averages hide important disparities. Children from the poorest households, children who live in rural areas, children from families with a specific social identity (caste or ethnicity), and/or children born to particularly vulnerable women are more often stunted than those born in better circumstances.

Throughout the world, child stunting is significantly more common in the poorest parts of society. This difference is particularly marked in South Asia: the prevalence of stunting in the poorest households (59 percent) is 2.4 times higher than the prevalence in the richest (25 percent). This compares unfavorably with sub-Saharan Africa, for instance, where the prevalence of stunting in the poorest households (48 percent) is 1.9 times higher than in the richest (25 percent).

Declines in the prevalence of child stunting have often been more pronounced in richer than in poorer households. For example between 1993 and 2006 in India – home to over 70 percent of the stunted children in South Asia – the prevalence of stunting declined by 42 percent in the richest group; the reduction in the poorest was only 14 percent.

Children who live in rural areas are more often stunted. The prevalence of child stunting is higher among children living in rural areas than among those living in urban settings. For example, the prevalence of stunting among rural underfives in Nepal is 57 percent higher than among urban underfives. The corresponding values for Bhutan and Pakistan are 28 percent and 30 percent, respectively.

Children from specific castes and ethnic groups are more often stunted. Caste and ethnicity underlie many of the disparities seen in the nutrition of children and women in South Asia. In India, for example, child stunting is more prevalent in Scheduled Castes (Dalit) and Scheduled Tribes (Adivasi) than in the rest of the population. Child underweight (low weight-for-age), child wasting (low weight for-height), or women’s under nutrition are also more prevalent in Scheduled Castes and Scheduled Tribes.

Children born to women without access to education are more often stunted. Lack of access to formal education for girls and women is closely linked to poor child nutrition in South Asia. In Bangladesh, India, Nepal and Sri Lanka the prevalence of stunting among children born to women without formal education is two and a half times higher (ranging from 41 to 57 percent) than among children born to women who have completed secondary education (14-26 percent).

INNOVATIONS AND IMPACTSIn Nepal, the prevalence of stunting in underfi ves dropped from 57 percent in 2001 to 41 percent in 2011...

WAY FORWARDIn Nepal, the prevalence of stunting in underfi ves dropped from 57 percent in 2001 to 41 percent in 2011...